Struggling with making an osteoporosis treatment decision

Hello @mrossi

Thank you so much for your "two cents," very helpful! I have very low t-scores and have had some bad falls, also not balance issues, and thankfully have not fractured anything. I'm hoping this means I have good "bone quality" despite apparently lacking density, if we are to trust DEXA testing. I've learned not all medical people involved in bone health do. Thanks for the book suggestions too.
I am seeing an endocrinologist in early January. I know meds will be strongly offered...again. Still finding this a difficult decision. Be well and thanks!

My Dexa testing was done at two different hospitals. They didn't give the same results. I am going by the one that is assoiciated with my spine surgeon. However, he can't fix my problem until my bones get stronger. That is why I am taking Evenity.

Hello heyhey, have you looked into using a non-prescription treatment? Don't be pushed into believing that pharmaceuticals are the only effective treatment! I too have osteoporosis and osteopenia. I've been taking AlgaeCal and Strontium with no side effects for almost 2 years. ( https://www.algaecal.com/ ) There is an AlgaeCal Community on Facebook where users share their results, and you can get answers to any questions. I'm due for my 2 year Dexa scan this summer, and am expecting to impress my doctor with the results.
I took Boniva and Actonel for a number of years, before my research alerted me to the long term side effects and overall poor results. During that time there was minor improvement in my Dexa scans, which reversed when I had to go off them.

What did you scan in 2021 show after using AlgaeCal and Strontium?

@kathleenin texas, strontium will make bone density on the DEXA seem better than it is, because strontium replaces calcium in the bones and is heavier.

Exactly.. that is the reason I skip it. Same as Fosomax.. just adds poor bone quality. If it’s too good to be true……

Strontium affects the way the DEXA sees bone density. There seems to be some disagreement on its effect on bone quality. I wish there was more consistent info!

First, on the ranelate form, which says it builds bone as well as inhibiting resorption, so bone quality would be better than with Fosamax presumably : "Strontium ranelate acts through dual mechanisms of inhibiting resorption by osteoclasts and maintaining or stimulating bone formation by osteoblasts. It has shown only a modest effect in preventing recurrent vertebral fractures. " https://americanbonehealth.org/medications-bone-health/why-strontium-is-not-advised-for-bone-health/

Then there is this:

But doesn’t supplemental strontium strengthen weak bone? The jury is in: and the answer is, it does not!. In a 2016 clinical trial in Osteoporosis International of elderly patients with wrist fractures, supplemental strontium (alongside calcium and vitamin D) did not significantly improve healing within a few months of injury. However, most research indicating that strontium strengthens bones has referenced its positive effect on bone mineral density in patients with osteoporosis, not a single fracture.

Consider that quantity does not guarantee quality. Bone naturally contains minerals such as calcium, magnesium, and phosphorus. The mineral strontium has a similar electric charge to calcium and can take its place in bone. The more mineral in bone matrix, the more dense the bone. Strontium increases bone density, especially the thickness of the outer, or cortical, layer of bone. While this increases bone’s compressive strength, it does not improve and can actually lower bone’s tensile strength- the ability to elongate and flex under pressure. Lacking elasticity, bone becomes brittle like a dried up tree branch. Your fracture risk is higher with more brittle bone. Moreover, strontium is heavier than calcium, so lots of strontium in bone artificially increases your score on a bone mineral density test without improving tensile strength. https://caltonnutrition.com/strontium-does-not-strengthen-your-bones/#:~:text=Strontium%20increases%20bone%20density%2C%20especially%20the%20thickness%20of,becomes%20brittle%20like%20a%20dried%20up%20tree%20branch.

Aside from this issue, it was determined to increase cardiovascular risks and clots.

When I had my first bone density in 2000, my spine was -3.6 and my hips -3.5 Over the past 23 years with fosomaxx and actonel, my hip scores improved some, down to -3.0. My spine never improved, but didn't get worse. My new density test this month showed a major improvement in my spine -2.7 and my hips -2.6. That's still osteoporosis, but so much better. From what I've been reading, improvement seems to be really good in the spine. Yale is my local hospital, so the doctors available to my family have been great and I don't question their treatments. As I noted, my only possible side effect was a minor rash that I think was due to my mild allergy to sulfa.

Cecilia... What doctor(s) have you seen at Yale? I live in CT and am struggling to find a good osteoporosis specialist.